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Clinical and Genetic Aspects of Psoriatic Arthritis "Sine Psoriasis"
RAFFAELE SCARPA, ELENA COSENTINI, FRANCESCO MANGUSO, ALFONSO ORIENTE, ROSARIO PELUSO, MARIANGELA ATTENO, FABIO AYALA, AGESILAO D'ARIENZO, and PASQUALE ORIENTE
ABSTRACT.
Methods. Fifty-seven patients (31 men, 26 women, mean age 46.32 ± 14.12 yrs) with undifferentiated spondyloarthropathy (SpA) were studied. Two subsets were defined: (1) 21 patients with familial psoriasis (12 men, 9 women, mean age 49.29 ± 14.17 yrs); (2) 36 patients without familial psoriasis (19 men, 17 women, mean age 44.58 ± 14.00 yrs). The prevalence of the following clinical variables was evaluated: low back pain, enthesopathy, dactylitis, distal interphalangeal (DIP) arthritis, spinal involvement, and discitis. In all patients the following HLA haplotypes were tested: B7, B13, B17, B18, B27, B38, Cw6, and DR7. Results. Dactylitis and DIP arthritis were markedly present in the articular subset with familial psoriasis (p < 0.0001) that also showed a high frequency rate of HLA-Cw6 (p < 0.0001 vs controls and patients without familial psoriasis). HLA-B27 was markedly frequent in patients without familial psoriasis (p < 0.0001 vs controls and p = 0.019 vs patients with familial psoriasis). In addition, in patients with familial psoriasis the log-linear model showed that the presence of HLA-Cw6 was related to the presence of DIP arthritis as well as dactylitis (likelihood ratio chi-square change of 5.891 and p = 0.015). Conclusion. A subset of patients with PsA "sine psoriasis" is identified by the occurrence of a SpA with dactylitis and/or DIP arthritis, presence of HLA-Cw6, and familial psoriasis in first or second-degree relatives. (J Rheumatol 2003;30:2638-40) Key Indexing Terms:
PSORIATIC ARTHRITIS "SINE PSORIASIS" From the Department of Clinical and Experimental Medicine, Rheumatology Research Unit, Immunohematology Unit, and Dermatology Unit, University Federico II, Naples, Italy. R. Scarpa, MD, Associate Professor of Rheumatology; F. Manguso, MD, PhD; A. Oriente, MD, PhD; R. Peluso, MD; M. Atteno, MD; A. D'Arienzo, MD; P. Oriente, MD, Professor of Rheumatology, Rheumatology Research Unit; E. Cosentini, BSc, Immunohematology Unit; F. Ayala, MD, Professor of Dermatology, Dermatology Unit. Address reprint requests to Dr. R. Scarpa, Rheumatology Research Unit, Department of Clinical and Experimental Medicine, University Federico II, via Sergio Pansini 5, 80131 Naples, Italy. e-mail: rscarpa@unina.it Submitted January 29, 2003; revision accepted May 12, 2003. |